Advancing Excellence in America’s Nursing Homes, a voluntary program promoted as an effort to improve quality of care in nursing homes, has ended after a decade. Unfortunately, the Centers for Medicare & Medicaid Services (CMS) will continue the website (“New name, new logo, same GREAT website!”[1]), which it has funded since 2006, in a new program called the “National Nursing Home Quality Improvement (NNHQI) Campaign.”[2] The Center for Medicare Advocacy (the Center) has viewed Advancing Excellence with skepticism since it was first announced in September 2006, viewing the Campaign as simply the most recent in a long line of ineffective voluntary quality improvement efforts promoted by the nursing home industry.[3] In 2006, the Center was concerned about the Campaign’s minimal goals, which were actually lower than the standards of care set by the Nursing Home Reform Law, and repetition of similar voluntary improvement initiatives championed by the industry over the years.

The Center heard about the end of Advancing Excellence in three ways.

First, on October 1, 2016, the following e-mail was forwarded to the Center:

Advancing Excellence Campaign Shutting Down

In a September 8th letter to participating nursing homes, Jay Sackman, the chair, claims victory and announces that the Advancing Excellence Campaign is closing it's [sic] doors.

The Campaign's leadership is turning it over to CMS.

The website is supported by CMS funding and will be rebranded to reflect the QIN-QIO work with nursing homes. Many of the campaign goals are directly aligned with the QIN-QIO task areas, including infections related to CDI, medication safety, and reducing

hospitalization & rehospitalization for communities of residents.

The website will continue to be a source for quality improvement tools and resources, in support of not only Campaign goals, but other national initiatives such as The National Partnership to Improve Dementia Care.

Second, on October 2, 2016, the Help Desk at Advancing Excellence responded to the Center’s September 30 e-mail inquiring about rumors that the Campaign had ended:

"AE" has two parts: the Campaign (the project – think website) and the Collaborative (the group of members/board).

The Collaborative is shifting direction and has turned over operation of the Campaign to CMS. CMS has funded the website development, functionality, analytics and help desk support since 2006 through a contract with Telligen, and will continue to do so. Over the coming weeks we'll be rebranding to "National Nursing Home Quality Improvement Campaign" (NNHQI Campaign). The website url will remain the same www.nhQualityCampaign.org. Nursing homes and other long term care providers are indeed still selecting goals and entering data.

Contrary to the Help Desk e-mail, few nursing facilities in the Campaign are actually entering data. In June 2015, the Center found that the overwhelming majority of facilities “participating” in Advancing Excellence had registered for the Campaign but taken no further action – that is, they did not enter any data.[4] In the five states that the Center reviewed 17 months ago – California, Connecticut, Georgia, Maine, and Tennessee – an average of 89% of Campaign participants had taken no action after they registered. In California, for example, 538 of 596 participants (96%) had only registered.

Finally, in an October 27 e-mail, CMS’s Michele Laughman describes “transition news” for Advancing Excellence. The e-mail reports that the campaign has been “a go-to source for quality improvement tools and resources,” addressing “national initiatives, including the Centers for Medicare & Medicaid Services (CMS) QIN-QIO work, The National Partnership to Improve Dementia Care in Nursing Homes, and the Centers for Disease Control and Prevention (CDC).” Laughman continues:

In August, 2016, the Advancing Excellence in Long Term Care Collaborative (AELTCC) transferred operation of its project, Advancing Excellence in America’s Nursing Homes Campaign, to CMS. The CMS and its contractors will sustain the Campaign’s mission of advancing quality and performance improvement in nursing homes [under the new name “National Nursing Home Quality Improvement (NNHQI) Campaign”].

The Center is disappointed that CMS is continuing the Campaign under a new name. This diverts attention from the statutory “duty and responsibility of the Secretary to assure that requirements which govern the provision of care in skilled nursing facilities under this subchapter, and the enforcement of such requirements, are adequate to protect the health, safety, welfare, and rights of residents and to promote the effective and efficient use of public moneys.”[5]